CN102368956B - 混合式手术器具 - Google Patents
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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Abstract
手术器具的一个实施例可以包括钉容纳器;由该钉容纳器容纳的钉;砧座,其中该钉容纳器和砧座中至少一个相对于另一个是可移动的;以及至少一个电极,其位于该钉容纳器和/或砧座的表面上。手术器具的另一个实施例可以包括钉容纳器;由该钉容纳器容纳的钉;砧座,其中该钉容纳器和该砧座中至少一个相对于另一个在开启形态和闭合形态之间可移动;其中在该闭合形态,该钉容纳器和该砧座之间存在可调节的开口;以及至少一个电极,其位于该钉容纳器和/或砧座的至少一个表面上。
Description
本申请要求2009年1月29日递交的美国临时专利申请号61/148,346,以及2009年6月3日递交的美国专利申请号12/477,302的优先权,其均以参考方式完全合并于此。
技术领域
本发明总体上涉及手术钉合和电灼。
背景技术
内切割器是一种手术工具,其钉合以及切割组织,以截断该组织,而保留该切割端为止血状态。内切割器的直径足够小,以用于极小侵入的手术,其通过套管针,接口,或在身体内的小切口到达手术位置。直线型切割器是内切割器的较大版本,其被用于截断胃肠道的部分。典型的内切割器在其远端容纳可弃的单次使用盒,该盒具有若干排钉,并包括相对于该盒的砧座。外科医生通过套管针或其它在身体内的接口或切口插入该内切割器,引导该内切割器的端部围绕于要被截断的该组织,并将该砧座和盒压到一起,以夹持该组织。然后将一排或多排钉部署在该截断线的两侧,并且沿着该截断线推进刀片,以划开该组织。电灼工具也是已知的,并已经被用于划开和封闭组织。
目前,用于切割组织的基于凝结作用的装置是已知的,其被用于手术过程中。这些装置可夹持组织,输送能量(如射频能量或超声)至组织,以引起凝结作用来热封闭该组织,然后用刀切割该组织。外科医生可以使用这种装置,例如,在准备肠手术时划开系膜组织。然而,在这种准备过程中,外科医生通常遭遇到比基于凝结作用的装置可以安全切割的更大的血管。因此,外科医生必须放弃该凝结作用装置,而转用可以部署钉的内切割器。该内切割器可以通过植入多个钉更安全地划开较大的血管以及其它高度血管化的组织。在工具之间切换费时,昂贵,而且不方便,特别是在极小侵入的,腹腔镜的,或接口通路的手术过程中,要被切割的组织可能会在撤回该工具后被漏失,以至于外科医生必须在插入不同的工具后重新花时间找到该组织。
当使用内切割器或其它利用砧座和盒或其它钉容纳器的手术钉合器时,该砧座和该盒被夹在一起时在该砧座和该盒之间保持基本恒定的间隙通常是重要的。该基本恒定的间隙对于适当的钉合形成是重要的。亦即,被从该盒或其它钉容纳器向外推动的钉被设计成在其行进中的某点遇到在该砧座中的钉穴或其它部分。如果该钉过早或过迟遇到该砧座中的钉穴或其它部分,该钉可能会变形。例如,如果该间隙过大,该钉可能不会被完全成形。作为另一个实施例,如果该间隙过小,该钉可能会被压碎。然而,当使用双极电灼工具时,将电极尽可能靠拢通常是重要的。其中这类工具利用两个颚,每个颚上可以提供一个或多个电极,其中在每个颚上的电极可以集体形成单极。以最小化其中间隙的方式把组织夹在这两个颚之间。通过这种方式,组织和每个颚保持良好的接触,以促进电流的流动。在该组织和一个或两个颚之间的空气间隙可降低该电灼工具的效力,并可导致不希望的临床结果。因此,一方面要求砧座和盒或其它钉容纳器之间有间隙,另一方面对于电灼工具要求跨越一个范围厚度的组织夹紧组织,两者彼此有分歧。
附图说明
图1是可在钉合和凝结作用方式之间切换的示范性的医疗装置的透视图,该装置包括把手和末端效应器。
图2是图1的示范性的末端效应器的透视图,其具有钉容纳器和砧座。
图3是图2的示范性的钉容纳器的俯视图。
图4是具有示范性的可调节间隙的末端效应器的一个实施例的侧视图。
图5是图4的末端效应器在第二形态的侧视图。
图5a是图4的末端效应器的侧视图,其具有偏离该砧座近端的弹簧。
图6是具有示范性的可调节间隙的末端效应器的另一个实施例的侧视图。
图7是图6的末端效应器在第二形态的侧视图。
图8是图6的末端效应器在第三形态的侧视图。
图9是其中限定有两级凸起表面的外套管的远端的侧剖面图。
图10是具有示范性的可调节间隙的末端效应器的另一个实施例的侧视图。
图11是图10的末端效应器在第二形态的侧视图。
图12是图10的末端效应器在第三形态的侧视图。
图13是具有示范性的可调节间隙的末端效应器的另一个实施例的前视图。
图14是图13的末端效应器在第二形态的前视图。
图15是具有示范性的可调节间隙的末端效应器的另一个实施例的侧视图。
图16是具有示范性的可调节间隙的末端效应器的另一个实施例的侧视图。
在不同的图中使用的相同参考标记表示类似或相同的部件。
发明内容
详细说明
递交于2007年9月6日,公开于2009年3月12日的美国专利公开号2009/0065552(“内切割器文献”)以参考方式被全文合并于此。该内切割器文献描述了一种手术钉合器,其包括与轴相连的末端效应器,该轴依次和把手相连。该内切割器文献还描述了延伸入该末端效应器的进料器带,钉由其中伸出并易卸地连接该进料器带。
参照图1,医疗装置2可以包括连接至轴6的末端效应器4,其依次连接把手8。该末端效应器4可以是一个或多个连接到该轴6的分离组件,或可以和该轴6的远端一起被整体制造。该轴6可以为刚性或柔性。该末端效应器4和该轴6可以调整尺寸,以穿过可以被放置通过患者组织的标准的套管针接口。有利地,该末端效应器4可以调整尺寸,以穿过开口直径在5-10毫米之间的套管针接口。或者,该医疗装置2可以被用于常规的开放式手术过程,该过程不使用套管针接口。或者,该医疗装置2可以被用于极小侵入的手术过程,该过程通过非套管针接口的机制或结构得以达到患者体内的手术位置,如Ethicon Endo-Surgery公司的LAP DISC手达到装置,或者该过程通过未放置接口或其它机制或结构的切口或开口得以达到患者体内的手术位置。
该把手8可以包括被适当地设置为驱动该末端效应器4的任何机制,多个机制,结构或多个结构。该把手8包括至少一个能量储存源,以用于驱动该末端效应器4。该源或能量储存源可以是机械的(如弹簧),电的(如电池),气压的(如压缩气体的缸)或任何其它适宜的能量储存源。用于驱动该末端效应器4的一种能量储存源,其规范,以及其使用可以如2005年2月9日递交的美国专利申请号11/054,265所述,其以参考方式被全文合并于此。该把手8可以替换式地包括,或者同时包括适于从外源接收储存能量的一个或多个连接器,如连接到压缩气体或真空的医院公共事业源的软管,或可连接至电源的电缆。
此外参照图2-3,该末端效应器4可以包括钉容纳器10和砧座12。该钉容纳器10和砧座12中至少一个相对于另一个可移动,以压或夹持其中的组织。该末端效应器4可以容纳多个钉或夹子,如内切割器文献中所述。有利地,该钉容纳器10被固定至该末端效应器4和/或该轴6的余部,并且不可由其卸下。该钉容纳器10可以不离开该患者而被施放多次,以使得每次部署钉或夹子后无需为了替换钉盒或其它组件而将该末端效应器4从该患者处撤出。尽管如此,如果希望的话,至少一部分该钉容纳器10可以从该末端效应器4和/或该轴6的余部卸下;该末端效应器4可以从该轴6卸下;和/或该轴6可以从该把手8卸下。例如,该钉容纳器10可以被设置为容纳可拆卸的盒,该盒可以被设置为多次或仅单次部署钉。该末端效应器4可以为内切割器,例如如该内切割器文献所述,或者可以是任何其它适宜的装置;该末端效应器4不局限于内切割器。在此内切割器中,至少一个进料器带延伸入该末端效应器4,并且至少一个钉被固定至该进料器带并可以易卸地由该进料器带分离。
这些钉或夹子可以通过该钉容纳器10的上表面16中的开口14进行部署。该开口14可以被设置为大体上沿着该钉容纳器10的上表面16纵向延伸的两排或两排以上。然而,该开口14可以被设置为不同方式。刀槽18可以沿着该钉容纳器10的上表面16的至少一部分延伸,以使刀可以沿着该槽滑动并划开组织。该刀槽18可以位于分离的两排开口14之间。有利地,至少两排开口14可以被布置在该刀槽18的每一侧上。
至少一个凝结表面20位于该钉容纳器10的上表面16上。每一个凝结表面20可以沿着该钉容纳器10的上表面16大体纵向地定向。至少一个凝结表面20可以与该钉容纳器10的上表面16中的至少一行开口14大体上平行,并在钉容纳器10的边缘或近边缘处由钉容纳器10一侧上的开口14水平向外设置。或者,至少一个凝结表面20可以和该钉容纳器10的上表面16中的至少一行开口14大体上平行,并位于该刀槽18和一行开口14之间。或者,至少一个凝结表面20可以被不同地定向。或者至少一个凝结表面20可以大体上为U形。这些开口14可以位于该U形的凝结表面20之内,或可以相对于该U形凝结表面另外定向。或者,该钉容纳器10的整个上表面16可以为凝结表面20。
每一个凝结表面20以任何适当方式连接至该把手8中的能源。例如,可以从凝结表面20伸出一根或多根导线或波导管通过该轴6到达该把手8中的能源。连接到每一个凝结表面20的能源可以不同于用于从该钉容纳器10部署夹子或钉的能源。例如,该把手8可以包括用于从该钉容纳器10部署钉的压缩气体的气缸,以及用于驱动该凝结表面20的和电能源的连接。该连接到每一个凝结表面20的能源也可以和用于从该钉容纳器10部署夹子或钉的能源相同。
每一个凝结表面20可以任何适宜的方式配置,以输送射频能量,超声,热,电或任何其它种类的能量至组织。例如,至少一个凝结表面20可以是完整的机制或其它装置,其被设置为将电能或其它能量转换为适于引起凝结的不同的种类的能量。这种机制和装置在本领域中是已知的。每一个凝结表面20均可以是双极凝结装置的电极,或者其每一个均可以是单极的。或者,该凝结表面20集体构成双极凝结装置的一个电极,并且该砧座12是另一个电极。该砧座12也可以包括一个或多个以任何适宜的方式布置在该砧座12上的凝结表面。或者,该砧座12可以包括代替该钉容纳器10的一个或多个凝结表面。或者,该凝结表面20可以集体为单极。
任选地,至少一个砧座12和/或钉容纳器10可以由陶瓷材料制造。至少一个凝结表面20可以直接位于这种陶瓷砧座12和/或钉容纳器10上,无需额外的绝缘。或者,陶瓷材料可以被置于该砧座12和/或该钉容纳器12的表面上,相应的凝结表面20之下,以绝缘该凝结表面20。任选地,该陶瓷材料可以是压电的,一个或多个反馈导线可以被连接至该陶瓷材料。该反馈导线可以被连接至该把手8和/或该电灼发生器。当该砧座12和钉容纳器10移动到一起,形成闭合,夹持的形态时,该陶瓷材料形成压电电压,其通过该反馈导线被传送。通过这种方式,可以根据从该反馈导线接收到的反馈对施加于该砧座12和钉容纳器10上的夹持力进行调节。
该末端效应器4可以被设置为根据使用者的选择从该钉容纳器10部署钉,或者施加能量至该凝结表面20。该把手8可以包括开关22,其容许该使用者在钉合模式和凝结模式之间切换。或者,该开关22可以位于该把手8之外的地方,并被连接至该医疗装置2。例如,该开关22可以是电连接至该把手8的脚踏开关。此种开关22可以是机械的,电的,它们的组合,或者不同种类的开关。该开关22可以使该医疗装置2在模式之间以任何适宜的方式切换。例如,该开关22的运动可以物理锁定这些钉,使其不能释放(比如通过将调整片移入和阀的接合,该阀连接为该末端效应器的钉合机制供能的气体的气缸),并基本上在同时接通或者完成电路,以允许驱动该凝结表面20。通过在模式之间切换,单一的触发器可以在每一个模式中被用于驱动该末端效应器。或者,可以省略该开关22,并且该把手8可以包括两个或两个以上触发器24或者其它驱动器,以使得该使用者驱动一个触发器24以部署钉,而驱动第二触发器24以驱动该凝结表面。或者,该把手8可以包括容许该使用者选择性地部署钉和凝结组织的任何其它特征部件。或者,该末端效应器4可以被设置为从该钉容纳器10部署钉,并同时施加能量至该凝结表面20,其或者取决于该使用者的选择,或者是作为该医疗装置2的唯一的操作模式。被施加于凝结表面20的能源可以是标准的电灼发生器。
夹持
在该末端效应器4被驱动以钉合或烧灼组织之前,该末端效应器4被移动至闭合,夹持形态。当期望钉合时,在该末端效应器4为夹持形态的时候,需要在该砧座12和钉容纳器10之间有基本上恒定的已知间隙。当期望电灼时,在该末端效应器4为夹持形态的时候,需要在该砧座12和该钉容纳器10之间的间隙尽可能小。因而,该末端效应器4将组织夹持在该砧座12和该钉容纳器10之间时可以是可控制的,第一方式是为了在其中保持基本上恒定的间隙,而第二方式是为了最小化其中的间隙。亦即,在该砧座12和该钉容纳器10之间有可调节的间隙。
参照图4,作为一个实施例,针26可以位于该砧座12上,在其近端,在或者接近该砧座12的底部表面。为了方便读者,术语“底部”指该砧座12在该页面上的方向,其不限制该砧座12在使用中的方向。该针26可以大体上为圆柱形,并从该砧座12水平向外延伸。有利地,使用两个针26,该砧座12的两侧一边一个,其中这类针26大体上为对称布置。每一个针26均延伸进入该钉容纳器10的槽28。每一个槽28均可以为大体竖直朝向,并且可以位于或接近该钉容纳器10的近端。每一个槽28均约束相应的针26的运动。阶段调节条30可以沿着该钉容纳器10在该钉容纳器10和该砧座12之间滑动。该调节条30可以在该钉容纳器10中的相应槽以及在该砧座12中的另一个相应槽34内滑动。该调节条30的上表面32可以包括复数个不连续的阶段。或者该调节条30的上表面32可以为角型,弯曲型,连绵型,或者其它形状。再参照图5,在该调节条30被向远侧移动时,该调节条30的上表面32可以接触该槽34的近端,促使该槽34的近端向上并从而促使该砧座12向上。当该砧座12向上移动时,每一个针26均在相应的槽28中向上移动。当每一个针26向上移动时,该砧座12和该钉容纳器10之间的枢轴点向上移动。因此该枢轴点向上移动,在夹持形态下该砧座12和该钉容纳器10之间的间隙增加。从而该调节条30可以位于用于钉合的相对于该砧座12的第一位置,以在该砧座12和钉容纳器10之间提供相对大的间隙,并且该调节条30可以向近侧移动,以减少间隙,用于电灼。有利地,再参照图5a,该砧座12的近端可以向下偏移(比如通过弹簧31),以使该调节条30在其向上移动该砧座12时抵消该偏移。
再参照图6,作为间隙调节的另一个实施例,该砧座12的近端可以包括两级凸起表面40。此凸起表面包括两个斜面42,44,它们以远侧方向向上延伸。该斜面42,44可以被平面区域46或者其它间隔物分离。该轴6可以在其远端包括外套管50,或者在其远端之上或之内是可滑动的。在该初始结构中,该砧座12和该钉容纳器10的近端可以各自延伸入该外套管50的管腔。该砧座12和钉容纳器10可以在枢轴点52可旋转地连接。当该外套管50向远侧推进时,该外套管50的远端遇到该第一斜面42,其位于该第二斜面44的近处。再参照图7,当该外套管50的远端对着该第一斜面42压迫时,该砧座12围绕该枢轴点52向该钉容纳器10向下回转。该外套管50推进,直至该平面区域46进入该外套管50的管腔。在这个时候,该砧座12和该钉容纳器10相互间隔以适于钉合的第一距离。该砧座12和该钉容纳器10之间的间隙是已知的,其适于钉的部署。再参照图7,该外套管50可以向远侧被进一步推进,直至该外套管的远端遇到该第二斜面44。当该外套管50的远端对着该第二斜面44压迫时,该砧座12围绕该枢轴点52向着该钉容纳器10向下回转。该外套管50可以被推进,直至该砧座12和该钉容纳器10之间的组织54妨碍进一步夹持,或者直到该外套管50到达平面区域56,在该砧座12上的停止位,或其行进的终点。此时,该砧座12和该钉容纳器10互相间隔以适于烧灼的第二距离,因为该第二距离小于该第一距离。或者,该钉容纳器10也可以,或者替代地,包括两级凸起表面40。或者,再参照图9,该外套管50也可以,或者替代地,包括限定于其管腔的远端内的两级凸起表面52。此凸起表面52为逆转的如上所述的两级凸起表面40,其作用方式基本上相同。该外套管50可以包括该两级凸起表面52,以替代或者加到在该砧座12和/或钉容纳器10的两级凸起表面40。
再参照图10,作为间隙调节的另一个实施例,该砧座12的近端可以包括向上偏移的凸起臂60。该凸起臂60可以在远侧方向被定向为向上。该凸起臂60的远端可以任何适宜的方式向上偏移。例如,可以在该凸起部臂60的下侧和该砧座12之间设置弹簧62。在该初始结构中,该砧座12的近端和该钉容纳器10可以各自延伸入该外套管50的管腔。该砧座12和钉容纳器10可以在枢轴点52可转动式地连接,其最初可以位于该外套管50的管腔内。在该外套管50被向远侧推进时,该外套管50的远端对着该凸起臂60的有角度的表面推压。参照图11,当要被夹持在该砧座12和该钉容纳器10之间的组织54足够薄时,需要用于夹持该组织54的力小于该弹簧62向上偏离该凸起臂60的远端所用的力。因此,由该外套管50的远端对着该凸起臂60施加的力基本上不会使该凸起臂60偏斜,而是使该砧座12相对于该钉容纳器10向下旋转至充分夹持位置。在该充分夹持位置中,该砧座12和该钉容纳器10之间的间隙可以为第一距离,其可以调整尺寸以促进该组织54的钉合,可选的,当该砧座12和该钉容纳器10之间的间隙为第一距离时,组织54可以被烧灼。参照图12,当要被夹持在该砧座12和该钉容纳器10之间的组织54较厚时,需要用于夹持该组织54的力大于该弹簧62向上偏离该凸起臂60的远端所用的力。因此,由该外套管50的远端对着该凸起臂60施加的力使该凸起臂60向下偏斜。从而该砧座12不完全闭合,因为至少一部分该外套管50对着该凸起臂60施加的力使该凸起臂60向下偏斜,而不是使该砧座12向下偏斜。亦即,该凸起臂60限制了可以被施加于组织54的力的总量,从而在最大夹持力上设置了一个上限。该组织54即可按照使用者的意愿被钉合或烧灼。
再参照图13,作为另一个实施例,该钉容纳器10可以包括朝向该砧座12的弹性凸面70。或者,该弹性凸面70可以位于该砧座上,朝向该钉容纳器10。该弹性凸面70可以为弹簧片或者任何其它适宜的机制。该弹性凸面70可以任何适宜的方式成型,其具有峰72,该峰72基本上水平地位于该弹性凸面70的中心,并且可以沿着该弹性凸面70的长度纵向延伸。然而,峰72可以被设置为任何其它适宜的方式。该弹性凸面70被设置为可保持其形状,直至特定的力被施加于其上,在这个时候该弹性凸面70偏斜和变平。当该砧座12和该钉容纳器10靠近到一起时,该弹性凸面70的峰72可以作为一个停止位,其阻止该砧座12和该钉容纳器10进一步一起运动。此时,该砧座12和该钉容纳器10之间的间隙可以为第一距离,该第一距离可以被有利地调整尺寸,用于将钉部署入组织54。此外参照图14,当更大的力被施加于该砧座12和/或钉容纳器10,以将它们压到一起时,该力使该弹性凸面70偏斜和变平,其克服先前由该峰72给予的阻力。由此,该峰72塌陷,该砧座12和钉容纳器10可以靠近到一起并以更大程度压缩该组织54。此时,该砧座12和该钉容纳器10之间的间隙可以为第二距离,该第二距离可以被有利地调整尺寸,用于该组织54的烧灼。此外,该凸面70通过该凸面70和该钉容纳器10或者砧座12的相对表面之间的压缩导致的“辗滚”作用使该被夹持的组织54干缩。这对于组织烧灼模式特别有用。
此外参照图15,作为另一个实施例,至少一个凝结表面20可以相对于该砧座12和/或钉容纳器10浮动。该凝结表面20可以位于一分离的电极载体80上,或者可能不需要或采用分离的电极载体80。该电极载体80可以通过枢轴方式在位于接近该电极载体80的远端的枢轴点82处连接至该砧座12,并且其也可以位于接近该砧座12的远端处。该电极载体80的近端可以通过弹簧84或者任何其它适宜的机制或者结构向下偏移。亦即,该电极载体80和相应的凝结表面20可以偏离该砧座12。该弹簧84以朝向该钉容纳器10的方向施加已知量的力于该电极载体80上,并由此固定该电极载体80的下表面,该凝结表面或者多个凝结表面20因此大体上平行于该钉容纳器10的上表面。因此,当某一厚度以下的组织被夹持在该砧座12和钉容纳器10之间时,该电极载体80不向上偏斜,以使得该电极载体80的下表面和该钉容纳器10的上表面之间存在已知的间隙。该电极载体80可以被设置为具有钉成形穴86或者其它结构,钉可以从该钉容纳器10对着这些结构发出并变形。当某一厚度以上的组织被夹持在该砧座12和钉容纳器10之间时,夹持该组织所需的夹持力导致该弹簧84压缩。通过这种方式,该电极载体80的下表面可在各种组织厚度下保持对组织有适宜的接触。
此外参照图16,作为另一个实施例,至少一个凝结表面20可以相对于该砧座12和/或钉容纳器10以不同于图15的凝结表面20的方式浮动。电极载体80可以通过一个或多个延伸自该砧座12的针88连接到该砧座12,其中每一个针88被收纳于该电极载体80中相应的槽90内。该电极载体80可以通过一个或多个弹簧84或者通过任何其它适宜的机制或者结构向下偏移。亦即,该电极载体80和相应的凝结表面20可以偏离该砧座12。该弹簧或者弹簧84以朝向该钉容纳器10的方向施加已知量的力于该电极载体80上。该电极载体80可以沿着该槽90滑动,其容许该电极载体80相对于该钉容纳器10上下浮动。这些槽90之一可以比一个或多个其它的槽90短,其容许该电极载体80绕轴旋转,该轴由至少一个针88形成,或者与其大致平行。因为该电极载体80的近端和远端可以摆动,该电极载体80可以沿着组织的长度与其保持接触。此外,该电极载体80可以另外方式偏离该砧座12,其方式是在较薄的组织被夹持在该钉容纳器10和该砧座12之间时,在该电极载体80的下表面上的凝结表面或者多个凝结表面20大体上平行于该钉容纳器10的上表面。
操作
以示范性的方式描述该医疗装置2的操作,其中该末端效应器4是内切割器。然而,该医疗装置2不局限于内切割器,而可以是任何用于切割组织和/或封闭组织的医疗装置。该末端效应器4由使用者放置于手术位置。作为一个实施例,手术位置位于要被截断的血管上。至少该砧座12的远端起初与该钉容纳器10隔开,以使该末端效应器4张开。在要被截断的该血管上推进该末端效应器4,直至该血管的全部直径位于该砧座12和该钉容纳器10之间。有利地,该血管基本上与该砧座12和该钉容纳器10成直角。然而,该血管可以相对于该砧座12和该钉容纳器10以任何其它适宜的角度定向。然后通过移动该砧座12,使之靠近该钉容纳器10,来闭合该末端效应器4,以使得该血管在该砧座12和该钉容纳器10之间被压缩。此末端效应器4的闭合可以用任何标准方式或者任何其它适宜的方式完成。作为一个实施例,可以在该砧座12和该钉容纳器10的外表面上向远侧推进一管,将该砧座12和该钉容纳器10压在一起。或者,该砧座12可以相对于该末端效应器4和/或该轴6的余部基本上被固定,并且可以移动该钉容纳器10,使之接近该砧座12,以闭合该末端效应器4。或者,该砧座12和该钉容纳器10均可朝向彼此移动,以闭合该末端效应器4。该末端效应器4的闭合可以通过驱动该把手8上的一个或多个控制器进行,和/或通过释放存储在该把手8中的能量进行。在该末端效应器4闭合之后,要被处理的该组织被该末端效应器4可靠地固定,并完全受其控制。
在该末端效应器4闭合之前或之后,使用者可以选择是否在该手术位置钉合该血管,或者使其凝结。使用者还可以选择如何夹持组织。亦即,可以选择调节该夹持形态中砧座12和该钉容纳器10之间的间隙。此选择可以在选择钉合或者凝结之前,之后,或者期间。或者可以根据钉合或者凝结的选择以某一方式自动进行组织夹持。可以通过任何适宜的方式如上所述进行组织的夹持。使用者可以选择钉合,如使用该开关22。然后该使用者操纵该把手8上的一个或多个控制器,以驱使该末端效应器4。从而通过该开口14部署钉,并且刀沿着该刀槽18滑动,以截断该血管,如内切割器文献所述。然后松开或者开启该末端效应器4,以释放被截断的血管。然后使用者可以将该末端效应器4移至另一根血管或者其它组织,再次夹持或闭合该末端效应器4,无需将该末端效应器4从该患者处移除,比如通过套管针或者其它接口通过该患者身体的外表面。如果该血管适于钉合,该组织可以被钉合以及截断。或者,该使用者可以选择凝结,用于截断该组织。使用者可以通过移动开关22,或者操纵与凝结相关的触发器24进行这样的操作。然后该把手8中的能源发射能量至该凝结表面20,导致和该凝结表面接触的血管的组织凝结和封闭。刀沿着该刀槽18滑动,以截断该血管。然后开启该末端效应器4,以释放被截断的血管。该医疗装置2因此可以在该患者体内重复使用,以在多个手术位点截断组织,既可以通过钉合也可以通过凝结。任选地,钉合和凝结(如通过电灼)是互相排斥的,意即使用者可以选择其一而不能同时选择两者。使用者可以这种方式继续,直至钉告罄,或者对在体内组织的处理完成。多次施放的钉合设备(如内切割器文献所述设备)的使用便于使医疗装置2重复用于处理患者体内不同尺寸,厚度和/或类型的组织。例如,在施放一组钉后,可以从该轴6和/或从该医疗装置2的余部推入复数个新的钉。通过这种方式,相比于常规医疗装置,处理患者体内的组织所需的时间和材料被减少。
术语“较上”,“较下”,“向上”,“向下”,“上”,“下”,“以下”,“以上”,“竖直”以及类似术语只是为了方便而被用于此文件中;这类术语指在印刷页面上的方向,而不限制该手术钉合器在使用中的方向。虽然本发明已经被详细地描述,不偏离本发明,其各种变化和改变以及采用的等价物对于本领域技术人员而言是显而易见的。应当理解本发明不局限于以上说明书中阐述的或者在附图中示意的结构的细节,组件的布置,和/或方法。在此文件的摘要中的陈述,以及此文件中的任何概要陈述都仅是示范性的;它们不是,也不能被诠释为对权利要求范围的限制。此外,附图仅是示范性的而非限制。题目标题和副标题仅是为了方便读者。它们不应当,也不能被解释为具有任何实质的重要性,含义或者解释,并且不应当,也不能被视为表明了所有与特定题目有关的信息是成立于,或者受限于任何特定的标题或者副标题。因此,除非根据以下权利要求和其合法等价物,否则本发明不受约束或者限制。
Claims (11)
1.手术装置,包括:
钉容纳器;
由所述钉容纳器容纳的复数个钉;
砧座,其中所述钉容纳器和所述砧座中至少一个相对于另一个在开启形态和闭合形态之间是可移动的;并且在所述闭合形态,所述钉容纳器和所述砧座之间存在可调节的间隙;及
位于所述钉容纳器和所述砧座中至少一个的表面上的至少一个电极。
2.如权利要求1所述的手术装置,进一步包括至少一个进料器带,其中至少一个所述进料器带的至少一部分延伸入所述钉容纳器;其中至少一个所述钉被固定至相应的所述进料器带,并可以由其易卸地被分离。
3.如权利要求1所述的手术装置,其中所述砧座可相对于所述钉容纳器绕针旋转,并且其中所述钉容纳器包括大体上竖直定向的容纳所述针的槽;其中所述砧座偏向所述开启形态;其进一步包括可在所述钉容纳器和所述砧座之间滑动,以选择性地促使所述砧座远离所述钉容纳器,从而在所述槽内向上移动所述针的分阶段调节条。
4.如权利要求1所述的手术装置,其中所述砧座和所述钉容纳器中至少一个的近端包括两级凸起表面;其进一步包括可相对于所述砧座和所述钉容纳器滑动,以连续地接合每一个所述凸起表面的外套管。
5.如权利要求1所述的手术装置,进一步包括其中包括管腔的外套管,所述外套管可相对于所述砧座和所述钉容纳器滑动,其中所述外套管的所述管腔的远端包括两级凸起表面,其可滑动,以接合所述砧座和所述钉容纳器中至少一个的近端。
6.如权利要求1所述的手术装置,进一步包括向上偏移的凸起臂,其被连接至所述砧座的近端,以及一外套管,其可相对于所述砧座滑动,以接合所述凸起臂。
7.如权利要求1所述的手术装置,其中至少一个所述电极被连接至并且偏离所述砧座。
8.如权利要求7所述的手术装置,其中至少一个所述电极的一端被枢轴式地连接至所述砧座。
9.如权利要求1所述的手术装置,其中所述砧座和所述钉容纳器中至少一个包括朝向所述砧座和所述钉容纳器中另一个的弹性凸面,其中所述弹性凸面在向其施加阈值力后偏斜和变平。
10.如权利要求1所述的手术装置,其中所述砧座和所述钉容纳器中至少一个的至少一部分是陶瓷,其中至少一个所述电极位于所述陶瓷上并被所述陶瓷绝缘。
11.如权利要求10所述的手术装置,进一步包括连接至所述陶瓷的反馈导线,其中所述陶瓷根据所述砧座经受的压力在所述闭合形态中产生压电电流,并且其中所述电流被沿着所述反馈导线传送。
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WO2010088044A2 (en) | 2010-08-05 |
EP2391278A4 (en) | 2014-06-11 |
CN102368956A (zh) | 2012-03-07 |
EP2391278A2 (en) | 2011-12-07 |
US20110278343A1 (en) | 2011-11-17 |
WO2010088044A3 (en) | 2010-10-21 |
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